Provider Demographics
NPI:1013950286
Name:LAYTON AMBULATORY ANESTHESIA, INC
Entity Type:Organization
Organization Name:LAYTON AMBULATORY ANESTHESIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-499-6464
Mailing Address - Street 1:P.O. BOX 3810
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3810
Mailing Address - Country:US
Mailing Address - Phone:801-727-2069
Mailing Address - Fax:678-285-6776
Practice Address - Street 1:1544 W ANTELOPE DRIVE
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1146
Practice Address - Country:US
Practice Address - Phone:801-773-3339
Practice Address - Fax:801-773-6727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X
UT207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055513Medicare ID - Type Unspecified
UT000055512Medicare PIN